Endoscope system

ABSTRACT

A laparoscopic trainer platform assembly includes: a training platform; a base, configured to accommodate at least one target array; the target array including a planar surface upon which are disposed a plurality of protruding targets oriented at various angles on the base; a left side support for supporting the training platform on the base; and a right side support for supporting the training platform on the base.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is continuation of U.S. application Ser. No.15/933,541, filed Mar. 23, 2018, which is a continuation of U.S.application Ser. No. 13/217,238, filed Aug. 24, 2011, and granted asU.S. Pat. No. 9,959,785, which claims the benefit of U.S. ProvisionalPatent Application No. 61/376,621 filed on Aug. 24, 2010. Each of theseapplications is herein incorporated by reference in its entirety.

FIELD OF THE DISCLOSURE

This disclosure relates to a system for surgeon training and, inparticular, to an apparatus and method for training a surgeon in thefundamentals of laparoscopic surgery.

BACKGROUND

The procedure of laparoscopic surgery has been in general use for over adecade. However, it has been noted that cognitive and psychomotor skillsrequired to perform laparoscopic surgery may be inadequate among somepractitioners, resulting in patient discomfort from, for example, bileduct injuries. Accordingly, there is a need for a certifying examinationby which a practitioner may be assessed for applicable cognitiveknowledge, technical skills, and clinical judgment.

SUMMARY

In one aspect of the present disclosure, a laparoscopic skills trainingsystem comprises: a trainer platform assembly including a trainingplatform; a base, the base configured to accommodate at least one targetarray; the target array including a planar surface upon which aredisposed a plurality of protruding targets oriented at a plurality ofangles on the base; a left side support for supporting the trainingplatform on the base; and a right side support for supporting thetraining platform on the base.

In another aspect of the present disclosure, the laparoscopic skillstraining system may further comprise: an accessory kit including one ormore of a suture block for a Penrose Drain, an appendage, a dexteritypeg board, a plurality of single-circle gauze pads, and a plurality ofdouble-circle gauze pads.

The laparoscopic skills training system may be used in conjunction withthe performance of a number of different skill sets, including:assessing competence in use of an endoscope; assessing grasper dexterityusing a peg board; evaluation of extracorporeal knot or intracorporealknot tying in a “Penrose drain”; practice in placement of a pre-tiedligating loop or reusable endoloop around an organ appendage; precisioncutting of a circular piece of gauze from a gauze pad; and practice ininsertion of a catheter into a cannulation tube.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing aspects, uses, and advantages of the present disclosurewill be more fully appreciated as the same becomes better understoodfrom the following detailed description of the present disclosure whenviewed in conjunction with the accompanying drawings, in which:

FIG. 1 is an isometric view of the basic elements of a laparoscopicskills training system, in accordance with the present disclosure.

FIG. 2 is an isometric view showing a training endoscope retained in atraining platform of the laparoscopic skills training system of FIG. 1.

FIG. 3 is a view of a central portion of the training endoscope of FIG.2.

FIG. 4 is a view of an end portion of the training endoscope of FIG. 2showing a video camera in a zero-degree position.

FIG. 5 is a view of an end portion of the training endoscope of FIG. 2showing the video camera in a thirty-degree position.

FIG. 6 is a view of the training endoscope of FIG. 2 with a zero-degreetarget array and a thirty-degree target array.

FIG. 7 is a detail view of the zero-degree target array of FIG. 6.

FIG. 8 is a detail view of the thirty-degree target array of FIG. 6.

FIG. 9 is an exemplary embodiment of an accessory kit comprising asuture block with a Penrose Drain, a foam organ with appendages, adexterity peg board, a plurality of single-circle gauze pad, and aplurality of double-circle gauze pads.

FIG. 10 is a perspective view of the dexterity peg board of FIG. 9placed in a working volume of the laparoscopic skills training system ofFIG. 1.

FIG. 11 is a detail view of the dexterity peg board of FIG. 10.

FIG. 12 is a detail view of the suture block with the Penrose Drain ofFIG. 9 showing a practice suturing operation using an extracorporealknot.

FIG. 13 is a detail view of the suture block of FIG. 9 showing apractice suturing operation using an intracorporeal knot.

FIG. 14 is a detail view of the foam organ with appendages of FIG. 9.

FIG. 15 is a diagrammatical view of a re-usable endoloop as may be usedwith the organ appendages of FIG. 14.

FIG. 16 illustrates a cutting procedure that may be performed using thesingle-circle gauze pad of FIG. 9.

FIG. 17 is a diagrammatical illustration of a cannulation fixturesuitable for insertion of a training catheter, in accordance with anexemplary aspect of the present disclosure.

FIG. 18 is a side view of the cannulation fixture of FIG. 17.

FIG. 19 is a top view of the cannulation fixture of FIG. 17.

FIG. 20 is a diagrammatical illustration of the training catheterinserted into the cannulation fixture of FIG. 17.

DETAILED DESCRIPTION

There are shown in FIGS. 1 and 2 isometric views of the basic elementsof a laparoscopic skills training system 10, in accordance with thepresent disclosure. The laparoscopic skills training system 10 includesa trainer platform assembly 20 comprising a training platform 21, a base23, a left side support 25, and a right side support 27, where thetrainer platform assembly 20 is secured to the base 23 by the left sidesupport 25 and the right side support 27. A display device 11, such as alaptop or a computer monitor, may be placed on or near the trainerplatform assembly 20, for use as described in greater detail below.

Emplacement of the training platform 21, the base 23, the left sidesupport 25, and the right side support 27 as shown define a workingvolume 29 for performing training skills, as described in greater detailbelow. In an exemplary embodiment, the left side support 25 and theright side support 27 are removably attached to the training platform 21and the base 23 such that these components can be disassembled forcompact storage or transport.

The platform 21 provides a generally planar platform surface 40, hereshown supporting a simulated skin 19, configured so as to enable a userto practice one or more tasks in a predefined skill set. The platform 21may include one or more openings, configured so as to provide at leastan endoscope opening 17, extending through the simulated skin 19 and theplanar surface 40.

The endoscope opening 17 is sized and positioned to accommodate astandard endoscope (not shown) or a training endoscope 30. The standardendoscope or training endoscope 30 may be used in conjunction with athirty-degree target array 50, as described in greater detail below. Theplatform surface 40 may further include a left port 41 and a right port43, each sized and positioned to accommodate a grasper (not shown) foruse as described in greater detail below.

The components and operation of the training endoscope 30 may bedescribed with reference to FIGS. 3 through 5 in which are shown anendoscope housing 31 into which are fitted a handle 33 and a viewingbarrel 35. The viewing barrel 35 has a first end fitted into theendoscope housing 31, as best shown in FIG. 3, and a second end having askewed barrel end 37 oriented at about thirty degrees with respect to abarrel axis 39, as best shown in FIG. 4. An inner barrel 61 is slidablyretained within the viewing barrel 35. The inner barrel 61 comprises alonger length than the length of the viewing barrel 35.

As best shown in FIG. 3, a video electronic module 60 is connected to afirst end of the inner barrel 61, and a video camera 63 is connected toa second end of the inner barrel 61. An electronic cable 45 runs insidethe length of the inner barrel 61 to convey electronic digital imagedata from the video camera 63 to the video electronic module 60, as isknown in the art. An output cable 65 may be connected to an output ofthe electronic module 60 so as to provide an image 13, and optionalelectronically-generated cross hairs 15, on the display device 11 (shownin FIG. 1). The video electronic module 60 may include switches 67 and69 to begin a countdown timer (shown in FIG. 1) and an elapsed-timetimer (not shown), for example, for use in a training session.

In a first mode of operation, camera navigation skills are developed,the optical axis of the video camera 63 is generally aligned with thebarrel axis 39, i.e., “zero degree axis.” In a second mode of operation,best shown in FIG. 3, the video electronic module 60 is moved away fromthe endoscope housing 31, causing the inner barrel 61 to move rearwardwithin the viewing barrel 35, until a latching button 71 protrudes toengage an end 73 of the viewing barrel 35. This causes the video camera63 to pivot approximately thirty degrees so as to orient the cameraoptical axis along a 30-degree viewing axis 75, as best seen in FIG. 5.

An elastic member 47, disposed within the inner barrel 61, is configuredand attached to the video camera 63 such that the video camera 63 isurged to rotate and to position itself against the skewed barrel end 37of the viewing barrel 35 when the inner barrel 61 has moved rearwardwithin the viewing barrel 35. If the latching button 71 is subsequentlydepressed, allowing the inner barrel 61 to move forward within theviewing barrel 35, the video camera 63 returns to the first mode ofoperation and the camera optical axis is again aligned with the barrelaxis 39, or zero degree axis, as best shown in FIG. 4.

In an alternative embodiment, the angle of the video camera 63 can bevaried continuously, in addition to using detents for viewing at zerodegrees or thirty degrees. In the alternative embodiment, positionindicators (not shown) may be provided on the inner barrel 61 such thatthe sliding movement of the inner barrel within the viewing barrel 35can be adjusted so as to position the video camera 63 at varying angles,according to which position indicator on the inner barrel remainsvisible at the end of the viewing barrel 35.

As best shown in FIG. 6, the training endoscope 30 can be used witheither the thirty-degree target array 50, emplaced as shown in FIG. 1,or a zero-degree target array 80, which can be substituted for thethirty-degree target array 50 in FIG. 1. As can be appreciated by oneskilled in the art, either or both the thirty-degree target array 50 orthe zero-degree target array 80 may be vacuum and heat-formed from aplastic sheet. When used with the zero-degree target array 80, thetraining endoscope 30 is placed into the first mode of operation inwhich the optical axis of the video camera 63 is aligned with the barrelaxis 39. When used with the thirty-degree target array 50, the trainingendoscope 30 is placed into the second mode of operation in which theoptical axis of the video camera 63 is aligned with the 30-degreeviewing axis 75.

As best seen in FIG. 7, in an exemplary embodiment the zero-degreetarget array 80 may comprise a generally planar surface 81 from whichprotrude a plurality of raised features 83 a-83 e. Each of the raisedfeatures 83 a-83 e includes a surface having provided thereon a target85. In performing a first skill set using the laparoscopic skillstraining system 10, the user begins by inserting the training endoscope30 through the simulated skin 19 into the working volume 29 via theendoscope opening 17.

The training endoscope 30 is placed into the first mode of operation.The user conducts a first skill set by maneuvering the trainingendoscope 30 so as to successively acquire each of the targets 85 by thevideo camera 63 and superimpose each target 85 within theelectronically-generated cross hairs 15 on the display device 11.Preferably, the series of acquisitions is performed within apredetermined amount of time. The predetermined time may be set by theuser, via the switch 67, and a countdown time value may be displayed onthe display device 11 (see FIG. 1). The zero-degree target array 80 mayinclude a finger hole 57 to enable the user to remove the zero-degreetarget array 80 from within the base 23.

As best seen in FIG. 8, in an exemplary embodiment the thirty-degreetarget array 50 may comprise a generally planar surface 51 from whichprotrude a plurality of raised features 53 a-53 e. Each of the raisedfeatures 53 a-53 e includes a surface having provided thereon the target55. Each of the raised features 53 a-53 e also includes a respectivecowl 57 a-57 e positioned so as to prevent a direct view of therespective target 55 from the endoscope opening 17. In performing asecond skill set using the laparoscopic skills training system 10, theuser inserts the training endoscope 30 into the working volume 29 viathe endoscope opening 17, places the training endoscope 30 into thesecond mode of operation, and maneuvers the training endoscope 30 sothat each of the targets 85 are successively acquired by the videocamera 63 and appear within the electronically-generated cross hairs 15on the display device 11 within a predetermined amount of time. Theswitch 69 may be used to begin an elapsed time, for example, and thevideo electronic module 60 may generate the elapsed time value fordisplay on the display device 11.

Additional skill sets may be performed using any of a plurality ofLaparoscopic Surgery Training (LST) simulation components provided in anaccessory kit 100, shown in FIG. 9. The accessory kit 100 may include aLST suture block 101, a LST foam organ 103 with appendages comprising ared foam material, a LST dexterity peg board 105, a LST single-circlegauze pad 107, and a LST double-circle gauze pad 109. Each of the LSTsuture block 101, the LST appendage 103, and the LST dexterity peg board105 may include a mechanical fastener, such as a hook-and-pile fastener(not shown), on the underside of the respective component for removableattachment to a mating mechanical fastener, such as a hook-and-pilefastener (not shown), on the base 23. The mechanical fastener serves toprevent movement of the particular component while the user isperforming a skill set, as described in greater detail below.

In an exemplary embodiment, the LST foam organ 103 may comprise twolayers of a foam material, heat sealed at the perimeter of the foamorgan 103 (with three appendages) so as to give the foam organ 103 a“puffy” configuration. It can be appreciated by one skilled in the artthat the single circle and the double circle can be imprinted onto therespective gauze pads 107 and 109 by any practical means such as, forexample, silk screening or stamping with ink.

For example, in a third skill set, shown in FIGS. 10-11, the user canposition a first grasper 111 through the left port 41 and a secondgrasper 113 through the right port 43, such that the graspers 111 and113 protrude into a working volume 119. A video camera 115 and at leastone light source 117 can be mounted to the underside of the platform 21to illuminate the LST dexterity peg board 105, for example, and allowthe user to view the actions of the graspers 111, 113 on the displaydevice 11.

In an exemplary embodiment, the user may use the graspers 111, 113 tomanipulate a plurality of triangular rings 121 among a plurality of pegs123 on the LST dexterity peg board 105. The LST dexterity peg board 105may be removably fastened to the base 23 using the hook and pilefastening pair secured to the underside of the LST dexterity peg board105 and to the surface of the base 23. In an exemplary embodiment, thetriangular rings 121 may be fabricated by an extrusion process, or anyother comparable fabrication process known in the relevant art.

The third skill set includes the process of transferring the pluralityof triangular rings 121 from a first group of pegs 123 to a second groupof pegs 123. A triangular ring 121 is grasped by the grasper 111, liftedfrom the corresponding peg 123, transferred to the grasper 113 inmidair, and placed over another peg 123. Once all triangular rings 121have been so transferred, the process may be repeated in reverse. In anexemplary embodiment, performance of the third skill set may be timed byusing the video electronic module 60 with an elapsed or remaining timedisplay provided on the display device 11.

In a fourth skill set, shown in FIG. 12, the user performs a simplesuture in a LST Penrose drain 131 that may be fabricated from an elasticmaterial, such as rubber or latex. The user sutures the LST Penrosedrain 131 using an extracorporeal knot by manipulating a knot-pusher 133and a grasper (not shown). This operation requires the user to place asimple stitch through two marks on either side of a longitudinal slit135 in the LST Penrose drain 131 and to tie the sutureextra-corporeally, using the knot pusher 133 to slide the knot down.This suturing operation may be timed by using the electronic module 60.

The LST Penrose drain 131 may include a hook-and-pile fastener 137 forremovable attachment to a corresponding hook-and-pile fastener 139 onthe base 23. In an exemplary embodiment, the LST Penrose drain 131 maybe fabricated by molding and may include the longitudinal slit 135 aspart of the molding process. The two marks provided on the LST Penrosedrain 131 are preferably produced by ink, or similar material, appliedto the surface of the LST Penrose drain 131 by any method known in theart, including via manual application. A pair of protrusions (not shown)on the LST Penrose drain 131 may serve as guides in the application ofthe ink or similar material to the LST Penrose drain 131 to produce thetwo marks.

In a fifth skill set, shown in FIG. 13, the user performs a simplesuture in the LST Penrose drain 131 using an intra-corporeal knot bymanipulating two needle drivers 141 and 143. This operation requires theuser to place the suture through two marks in the longitudinal slit 135and to tie the suture intra-corporeally, transferring a needle 145between the needle drivers 141 and 143 between knot-tying throws. Thissuturing operation may be timed by using switches 67 and 69 (e.g.,buttons) provided on the electronic module 60.

In a sixth skill set, shown in FIGS. 14 and 15, the user attaches thefoam organ 103 to a fastener 139 which is secured to the base 23, suchthat a plurality of appendages 151 are free to move. The user canmanipulate a grasper (not shown) to place a pre-tied ligating loop orreusable endoloop 153 around one of the appendages 151. The user canthen secure the knot of the pre-tied ligating loop or reusable endoloop153 on the appendage 151, and simulate cutting the thread with a grasper111. This operation may be timed by using either of the switches 67 and69 on the electronic module 60. In an exemplary embodiment, the reusableendoloop 153 may be placed into a folded sheet of corrugated paper (notshown) for protection in shipping or storage.

A seventh skill set, shown in FIG. 16, includes the process of precisioncutting a circular piece of gauze 161 from the LST single-circle gauzepad 107. A pair of clips 167, such as alligator clips, may be used toplace the gauze in tension so as to enable cutting. Alternatively, aless skilled user may elect to cut the circular piece of gauze 161 fromthe LST double-circle gauze pad 109 (shown in FIG. 9). The LSTsingle-circle gauze pad 107 may be grasped by the grasper 111, and cutusing endoscopic scissors 163. A penalty may be assessed if the userdeviates from a circular line 165. In an exemplary embodiment,performance of the seventh skill set may be timed by using the switch 67(e.g., a button) or the switch 69 on the video electronic module 60 withan elapsed or remaining time display provided on the display device 11.

In an eighth skill set, the user may perform a cannulation task by firstemplacing in the base 23 a LST cannulation fixture 170, shown in FIGS.17-19. The LST cannulation fixture 170 includes a cannulation tube 171secured to a cannulation base 173 by a first clamp 175 and a secondclamp 177. The cannulation base 173 may be attached to the base 23 by ahook-and-pile fastener 169. The task requires the user to insert a LSTcatheter 180 into a cannulation tube opening 179 in the cannulation tube171 such that a catheter mark 181 is moved into position proximate thecannulation tube opening 179.

The catheter 180 may be provided with a metal pin (not shown) at theentry end to assist in guiding the catheter 180 into the cannulationtube opening 179. Moreover, the catheter 180 may include circumferentiallines (not shown), in black ink for example, to indicate to thepractitioner of the eighth skill set the depth to which the catheter 180has entered the cannulation tube 171 via the cannulation tube opening179.

The LST catheter 180 may alternatively include a marking string 185(with marks) placed inside a catheter outer tube 183, as shown in FIG.20. The marking string 185 is attached to a catheter pin 187, andincludes the catheter mark 181 placed adjacent a cannulation tube mark189, as shown. The marking string 185 may function to indicate to thepractitioner of the eighth skill set the depth to which the catheter 180has entered the cannulation tube 171 via the cannulation tube opening179.

It is to be understood that the description herein is exemplary of thedisclosure only and is intended to provide an overview for theunderstanding of the nature and character of the disclosure as it isdefined by the claims. The accompanying drawings are included to providea further understanding of various features and embodiments of themethod and apparatus of the disclosure which, together with theirdescription serve to explain the principles and operation of thedisclosure.

Thus, as stated above, while the disclosure has been described withreference to particular embodiments, it will be understood that thepresent disclosure is by no means limited to the particularconstructions and methods herein disclosed and/or shown in the drawings,but also comprises any modifications or equivalents within the scope ofthe claims. Further, the purpose of the Abstract is to enable the U.S.Patent and Trademark Office, the public generally, and in particularpractitioners in the art who are not familiar with patent or legal termsor phraseology, to determine from a cursory inspection the nature andessence of the technical disclosure of the application. Accordingly, theAbstract is not intended to define nor limit the claims in any way.

What is claimed is:
 1. A system comprising: an endoscope comprising aviewing barrel and an inner barrel, the inner barrel being slidablyretained within the viewing barrel; a video camera connected to theendoscope, the video camera configured to generate a digital image; avideo electronic module connected to the endoscope, the moduleconfigured to receive the digital image from the video camera; and adisplay operatively coupled to the video electronic module, the displayconfigured to present the digital image from the video camera.
 2. Thesystem of claim 1, wherein the video electronic module provides both thedigital image from the video camera and an electronically generatedimage to the display.
 3. The system of claim 1, further comprising anelectronically generated image configured to overlay the digital imagefrom the video camera when presented on the display.
 4. The system ofclaim 1, wherein the video electronic module includes at least oneswitch, the at least one switch configured to manipulate anelectronically generated image presented on the display.
 5. The systemof claim 1, wherein the endoscope is configured to operate in a firstmode and a second mode, wherein in the first mode the video camera isaligned with a barrel axis of the endoscope, and in the second mode thevideo camera is positioned at an angle relative to the barrel axis. 6.The system of claim 1, wherein the video camera is adjustable along oneend of the endoscope so as to continuously vary an angle of the videocamera relative to a barrel axis of the endoscope.
 7. The system ofclaim 1, further comprising an electronically generated image comprisinga plurality of concentric circles and a plurality of parallel lines, theplurality of parallel lines being secant lines relative to at least oneof the plurality of concentric circles.
 8. The system of claim 1,further comprising an electronically generated image comprising a set ofcrosshairs, the set of crosshairs providing an outline of a target. 9.The system of claim 8, wherein the outline comprises at least twoconcentric circles and at least two parallel horizontal lines, the atleast two parallel horizontal lines disposed within the at least twoconcentric circles.
 10. The system of claim 1, further comprising anelectronically generated image comprising at least one of a countdowntimer and an elapsed time timer.
 11. The system of claim 10, wherein thevideo electronic module includes one or more switches to activate atleast one of the countdown timer and the elapsed time timer presentedwithin the electronically generated image.
 12. The system of claim 1,wherein the display is configured to present at least one of a countdowntimer and an elapsed time timer in addition to the digital image and anelectronically generated image.
 13. The system of claim 12, wherein atleast one of the countdown timer and the elapsed time timer aresuperimposed onto the electronically generated image.
 14. The system ofclaim 1, wherein the display is further configured to simultaneouslypresent at least one of a countdown timer and an elapse time timer withat least one of the digital image and an electronically generated image.15. The system of claim 1, wherein the endoscope comprises a viewingbarrel and an inner barrel, the inner barrel being slidably retainedwithin the viewing barrel.
 16. The system of claim 15, wherein the videoelectronic module is connected to a first end of the inner barrel of theendoscope and the video camera is connected to a second end of the innerbarrel opposite the first end.
 17. The system of claim 15, furthercomprising an elastic member disposed within the inner barrel of theendoscope and attached to the video camera, the elastic memberconfigured to urge the video camera to rotate against a skewed barrelend of the viewing barrel.
 18. The system of claim 15, furthercomprising a cable within the inner barrel of the endoscope, the cableconfigured to convey the digital image from the video camera to thevideo electronic module.
 19. The system of claim 15, wherein the innerbarrel includes a length longer than a length of the viewing barrel,such that movement of the inner barrel within the viewing barrel allowsthe video camera to rotate against a skewed barrel end of the viewingbarrel and thereby change an angle of the video camera relative to abarrel axis of the endoscope.
 20. The system of claim 19, wherein theangle of the video camera is continuously adjustable relative to thebarrel axis of the endoscope.
 21. The system of claim 19, wherein theangle of the video camera is adjustable between 0 and 30 degreesrelative to the barrel axis of the endoscope.
 22. The system of claim19, wherein movement of the inner barrel relative to the viewing barrelis in a rearward direction along the barrel axis of the endoscope. 23.The system of claim 15, wherein the inner barrel includes a retractablelatch, the retractable latch configured to extend above an outer surfaceof the inner barrel so as to prevent forward movement of the innerbarrel within the viewing barrel.